Provider Demographics
NPI:1629406533
Name:GUNNING, DRAKE H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DRAKE
Middle Name:H
Last Name:GUNNING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DRAKE
Other - Middle Name:H
Other - Last Name:GUNNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:236 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-4238
Mailing Address - Country:US
Mailing Address - Phone:850-508-4624
Mailing Address - Fax:
Practice Address - Street 1:1266 CEDAR CENTER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4876
Practice Address - Country:US
Practice Address - Phone:850-508-4624
Practice Address - Fax:850-512-1301
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW150931041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health